Provider Demographics
NPI:1124365853
Name:WOOTTON, AMY ROSE (MSW)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:ROSE
Last Name:WOOTTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WASHINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4606
Mailing Address - Country:US
Mailing Address - Phone:541-908-5495
Mailing Address - Fax:
Practice Address - Street 1:1075 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4606
Practice Address - Country:US
Practice Address - Phone:541-908-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health